Breast Duct Discharge

Posted on

Q) Greenish breast discharge seen in 
A. Fibrocystic ds
B. Duct Ectasia

C. Paget ds.
D. Duct papilloma

Paget disease of Breast

Posted on

Q) True regarding Paget's disease of the breast
A. Seen in 5-10% Carcinoma  breast
B. 50-60% associated with underlying mass
C. Treated by MRM always

d) Radiotherapy is the treatment of choice

Ans b 50% have underlying mass 

Paget disease accounts for 1% or less of breast malignancies. It is characterized clinically by nipple erythema and irritation with
associated pruritus and may progress to crusting and ulceration. ( Sabiston page 860)

Paget disease is a condition of the nipple that is commonly associated with an underlying breast cancer  More than 95% of patients with Paget disease have an underlying breast carcinoma. Paget disease may be accompanied by a palpable mass in slightly more than 50% of Epidermal layer of skin is involved. Clinically, dermatitis occurs that may appear eczematoid and moist or dry and psoriatic.

Treatment of Paget disease

(i) mastectomy with axillary staging 

(ii) wide local excision of the nipple and areola to achieve clear margins, axillary staging, and radiation therapy. 

Axilla management in CA breast

Posted on

Q) 47 year old premenopausal lady with a 3X 3cm left breast lump with IDC grade III, TNBC.

On examination, there is a  single subcentimetric mobile soft mobile ipsilateral  axillary LN palpable.

Usg nodes no loss of hilum.  Management of axilla? Ans is free

a) SlND

b) ALND

c) Radiotherapy only

d) No treatment

Ans a

Selective lymph node dissection

ACOSOG Z0011 trial 0  (stages I and II) in patients who undergo breast conservation therapy, axillary lymph node dissection does not improve locoregional controlor survival.

This trial has demonstrated the safety of limiting axillary surgery to the SLNB without performing formal axillary dissection for sentinel node positivity.

This  avoids of the  morbidity of the axillary dissection.

If nodes positive the patient should receive adjuvant chemotherapy and radiation therapy.

Tamoxifen in breast cancer

Posted on

Q) Optimal duration of  tamoxifen in premenstrual women
a. 5 yrs
b. 10 yrs

c 3

d 15

Sentina Trial

Posted on

Q) According to SENTINA trial how many minimum sentinel lymph nodes to be removed (Onco 2019)
A. 1
B. 2
C. 3
D. 4

Other Onco Mcqs

natural history breast cancer

Posted on

Q. True about breast cancer is?

a) Doubling time of breast tumor is 1 month

b) Skip metastasis in level iii lymph nodes is common

c) Lungs are commonly involved by direct invasion

d) Dimpling of skin is due to shortening of cooper's ligaments

Ans

CDH 1 mutation

Posted on

Q ) Hereditary diffuse Gastric carcinoma is associated with which  breast cancer
A. Ductal carcinoma NOS subtype
B. Lobular carcinoma
C. DCIS
D. Metaplastic carcinoma

Answer for Q 79

Majority of Gastric Cancers are sporadic,

1–3% of GCs arise as a result of inherited cancer predisposition syndromes.

 Li-Fraumeni syndrome, Lynch syndrome, Peutz-Jeghers syndrome, hereditary breast and ovarian cancer,MUTYH-associated adenomatous polyposis (MAP), familial adenomatous polyposis,  juvenile polyposis syndrome and PTENhamartoma tumour syndrome (Cowden syndrome).

Read on for answer

Breast Cancer Management

Posted on

Q) Management of occult breast cancer with N1 lymph nodes:

a) Modified radical mastectomy (MRM) with axillary dissection

b) MRM with radiotherapy to axilla

c) Only axillary dissection with radiotherapy and chemotherapy to axilla

d) Simple mastectomy with chemotherapy

Answer for premium members

Phyllodes tumor

Posted on

Q) Which of the following is true about phyllodes tumor?

a) It has a fast spread and is locally invasive

b) It is benign proliferative in ANDI

c) Mammography is diagnostic

d) Young patients less than 20 years old are more commonly involved

answer for Premium members only-  

Discuss about Phyllodes tumor and their malignant potential.

Ductal carcinoma in situ

Posted on

Q) IN RTOG trial for ductal carcinoma in situ (DCIS) favourable tumor was defined as

a) <3,5 cm in size and 2mm free resection margin

b) <2.5 cm and 2mm margin

c) <3 cm size and 3 mm margin

d) <2.5 cm size and 3 mm margin

Answer - Free answers to surgery mcqs
d

Ductal carcinoma in situ is a pre invasive state in which the cancer cells have not breached the epithelial membrane. It can develop into cancer in 20%.

Simple mastectomy is the standard of care but many centers now consider it over treatment.

Van Nuys system uses

  1. Age of the patient
  2. type of DCIS
  3. presence of microcalcification
  4. Size
  5. resection margin

On mammography this is seen as clustered clustered calcification

Treatment options are 

  1. Mastectomy
  2. Breast conserving therapy (Lumpectomy +radiation and hormonal)

More recently, Eastern Cooperative Oncology Group investigators reported the frst result of a relatively large prospective single-arm study of surgery with negative margins of at least 3 mm without radiation therapy for patients with favorable subsets of DCIS.

 Patients with low-grade or intermediate-grade DCIS measuring 2.5 cm or smaller had a 5-year rate of ipsilateral breast recurrence of only 6.1%. In contrast, patients with high-grade disease had a much higher 5-year ipsilateral breast recurrence rate of 15.3%.

REF : Sabiston 853

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334775/